Lecture #8 - Adverse Neurodynamics

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Questions and Answers

What are the four alternate names for adverse neurodynamics?

Neural tension, neural tissue tension, dural tension, neural mechanosensitivity.

Which two components of nerves does neurodynamics relate to?

Mechanics and physiology.

What are the two ways nerves slide mechanically, as related to neurodynamics?

Longitudinally and transversely.

Name two factors that can reduce blood flow to and from nerves.

<p>Elongation by 18-22% and compression.</p> Signup and view all the answers

What is meant by adverse neurodynamics?

<p>Tension and/or compression issues involving the nerves.</p> Signup and view all the answers

How many naturally occurring convergence points are there, and what are they?

<p>There are six: C6, T6, L4, elbow, shoulder, and knee.</p> Signup and view all the answers

What should the neurodynamic testing procedure prioritize?

<p>Sequential and progressive movements without causing nerve injury.</p> Signup and view all the answers

Which side should be tested first when assessing for adverse neurodynamics?

<p>The affected side.</p> Signup and view all the answers

Explain why sensitizing movement is particularly useful for higher flexibility athletes.

<p>Sensitizing movement is useful for higher flexibility athletes because it allows for further stretching or compression of neural structures, which is essential for optimizing their flexibility and performance.</p> Signup and view all the answers

What terminology should be avoided when discussing neurodynamic test results and what should be used instead?

<p>The terms 'positive' and 'negative' should be avoided; instead, use 'normal' and 'abnormal' or 'clinically relevant'.</p> Signup and view all the answers

Under what circumstances should neurodynamics be integrated into a rehabilitation program?

<p>Neurodynamics should be integrated when optimizing patient conditions and symptoms, particularly after addressing other rehabilitation priorities.</p> Signup and view all the answers

What should palpation relating to adverse neurodynamics be based on?

<p>Palpation should be based on conditions, injuries, and pathologies that are potentially linked with neurodynamics.</p> Signup and view all the answers

List three differential diagnoses associated with adverse neurodynamics.

<p>Three differential diagnoses are radiculopathy, peripheral nerve entrapment, and chronic regional pain syndrome.</p> Signup and view all the answers

What is the recommended terminology to describe neurodynamic test results, and why is it important?

<p>Use 'normal' or 'abnormal' instead of 'positive' or 'negative' to ensure clarity and relevance in clinical communication.</p> Signup and view all the answers

Why might palpation produce symptoms in the context of neurodynamics?

<p>Palpation may reproduce symptoms due to the physical deformation of an irritated nerve during assessment.</p> Signup and view all the answers

In what scenarios would you prioritize other rehabilitation components over neurodynamics?

<p>Prioritize other components first if they address immediate functional impairments before integrating neurodynamics for optimization.</p> Signup and view all the answers

Name two conditions that should be considered while assessing for adverse neurodynamics?

<p>Muscle strain and peripheral nerve entrapment are two conditions to consider.</p> Signup and view all the answers

What are some physical differences to look for when assessing side-to-side neurodynamic responses?

<p>Differences in pain, size, shape, and texture should be evaluated when assessing side-to-side responses.</p> Signup and view all the answers

What happens mechanically to nerves during adverse neurodynamics?

<p>Nerves experience tension and/or compression issues.</p> Signup and view all the answers

What physiological factors are related to adverse neurodynamics?

<p>Blood flow and sensitivity issues involving the nerves.</p> Signup and view all the answers

Describe the importance of convergence locations in the context of adverse neurodynamics.

<p>Convergence locations provide stability to the spinal cord and create natural sites of tension.</p> Signup and view all the answers

What are the three steps of nerve movement during a neurodynamic test?

<p>Taking up the slack, sliding towards the pull, and elongating.</p> Signup and view all the answers

What is the role of blood flow in the physiology of adverse neurodynamics?

<p>Blood flow nourishes the nerve and dura, affecting their function.</p> Signup and view all the answers

What should be the approach towards neurodynamic testing?

<p>Neurodynamic testing should be sequential and progressive.</p> Signup and view all the answers

How should clinicians differentiate structural movements during neurodynamic testing?

<p>By moving relevant structures remotely without moving adjacent musculoskeletal structures.</p> Signup and view all the answers

What must be considered when applying stress during neurodynamic testing?

<p>The direction in which the stress is applied can create tension on the nerves.</p> Signup and view all the answers

What should be the primary focus before integrating neurodynamics into rehabilitation?

<p>Other rehabilitation components should be prioritized first.</p> Signup and view all the answers

How should clinicians interpret a neurodynamic test result that reproduces symptoms?

<p>The result should be described as a neurodynamic response, not a positive test.</p> Signup and view all the answers

What are two types of differences that should be observed in side-to-side neurodynamic assessments?

<p>Differences in pain/symptomology and size/shape/texture.</p> Signup and view all the answers

Explain why the physical deformation of an irritated nerve is significant during palpation assessments.

<p>It may reproduce pain and indicate adverse neurodynamic conditions.</p> Signup and view all the answers

While assessing neurodynamics, what should palpation be linked to?

<p>It should be based on conditions, injuries, and pathologies associated with neurodynamics.</p> Signup and view all the answers

What is the primary consequence of elongated nerves reaching 18-22% of their length?

<p>Reduced blood flow to the nerves.</p> Signup and view all the answers

What is the fundamental difference between the longitudinal and transverse sliding of nerves?

<p>Longitudinal sliding withstands tension, while transverse sliding withstands compression.</p> Signup and view all the answers

Explain the role of sensitizing movement during neurodynamic assessments.

<p>Sensitizing movement helps assess nerve responses during testing by introducing controlled tension.</p> Signup and view all the answers

Describe the effect of compression on the nervous system in the context of neurodynamics.

<p>Compression diminishes blood flow and sensitivity, which can propagate problems in the nervous system.</p> Signup and view all the answers

Identify the sequence of steps that should be followed in neurodynamic testing.

<p>The sequence should involve taking up slack, sliding, and applying tension.</p> Signup and view all the answers

What must clinicians avoid when differentiating structural movements during neurodynamic testing?

<p>Clinicians cannot completely isolate the nervous system during the process.</p> Signup and view all the answers

Why do naturally occurring convergence locations provide stability to the spinal cord?

<p>They create natural sites of tension that stabilize the spinal cord.</p> Signup and view all the answers

What should be the priority when assessing the affected side during neurodynamic testing?

<p>The affected side should be tested first.</p> Signup and view all the answers

Why should clinicians avoid using 'positive' and 'negative' when discussing neurodynamic test results?

<p>'Positive' and 'negative' can be misleading; instead, clinicians should use 'normal' or 'abnormal' to provide clearer clinical relevance.</p> Signup and view all the answers

What is the main consideration when including neurodynamics in a rehabilitation program?

<p>Neurodynamics should be included when optimizing patients, particularly when other primary rehabilitation aspects have been prioritized.</p> Signup and view all the answers

In palpation related to adverse neurodynamics, what key symptom should be reproduced, and what does it indicate?

<p>The reproduction of pain indicates a neurodynamic response, which signifies physical deformation of an irritated nerve.</p> Signup and view all the answers

List three conditions that may appear in differential diagnoses for adverse neurodynamics.

<p>Muscle strain/pathology, radiculopathy, and thoracic outlet syndrome are examples of conditions linked to adverse neurodynamics.</p> Signup and view all the answers

What does 'side to side differences' refer to in the context of neurodynamic assessments?

<p>Side to side differences denote variations in pain, size, or sensitivity between the affected and unaffected sides.</p> Signup and view all the answers

How does neural tension relate to both mechanical and physiological aspects of nerves?

<p>Neural tension affects the ability of nerves to withstand longitudinal tension and transverse compression, while also influencing blood flow and sensitivity.</p> Signup and view all the answers

What is the significance of the three steps of spinal cord and nerve movement during a neurodynamic test?

<p>These steps ensure that the nerve accommodates tension, slides towards the pull, and elongates without injury.</p> Signup and view all the answers

Discuss why the order of stress application is important in relation to the tethering of the dura.

<p>The order impacts whether the tethering causes upward or downward pulling, which can influence nerve function and symptoms.</p> Signup and view all the answers

Explain the role of naturally occurring convergence locations in maintaining spinal cord stability.

<p>These points create sites of natural tension that help stabilize the spinal cord against mechanical forces.</p> Signup and view all the answers

How do longitudinal and transverse sliding contribute to nerve health during neurodynamic testing?

<p>Longitudinal sliding helps withstand tension, while transverse sliding mitigates compression effects on nerves.</p> Signup and view all the answers

Identify the physiological factors indicated by the acronym BISy that are relevant to adverse neurodynamics.

<p>BISy refers to Blood flow, Inflammation, and Sensitivity, which are critical to nerve health.</p> Signup and view all the answers

What should be the primary approach when performing neurodynamic testing to ensure patient safety?

<p>The approach should be sequential and progressive, prioritizing taking up slack, sliding, and then applying tension.</p> Signup and view all the answers

Why is it essential to test the affected side first in neurodynamic assessments?

<p>Testing the affected side first provides a baseline for understanding how the nerve is functioning in relation to symptoms.</p> Signup and view all the answers

Which of the following conditions is NOT associated with adverse neurodynamics?

<p>Asthma (B)</p> Signup and view all the answers

Neurodynamics should always be the priority in rehabilitation.

<p>False (B)</p> Signup and view all the answers

What term should replace 'positive' or 'negative' when describing neurodynamic test results?

<p>normal or abnormal</p> Signup and view all the answers

The reproduction of symptoms during palpation is referred to as a __________ response.

<p>neurodynamic</p> Signup and view all the answers

Match the differential diagnoses with their descriptions.

<p>Disc pathology = Injury to the intervertebral discs Brachial plexus injury = Damage to the network of nerves supplying the arm Stenosis = Narrowing of the spinal canal Multiple sclerosis = A disease affecting the central nervous system</p> Signup and view all the answers

Which of the following statements is true regarding adverse neurodynamics?

<p>Neurodynamics affects both mechanical and physiological aspects. (D)</p> Signup and view all the answers

Nerves slide only in a longitudinal direction to withstand tension.

<p>False (B)</p> Signup and view all the answers

What is one possible consequence of diminished blood flow to nerves?

<p>Propagation of neural problems</p> Signup and view all the answers

The two directions in which nerves slide are __________ and __________.

<p>longitudinally, transversely</p> Signup and view all the answers

Match the convergence points to their respective locations:

<p>C6 = Cervical region T6 = Thoracic region L4 = Lumbar region Elbow = Joint Shoulder = Joint Knee = Joint</p> Signup and view all the answers

What must clinicians emphasize when performing structural differentiation during neurodynamic tests?

<p>Nervous system functionality (C)</p> Signup and view all the answers

During neurodynamic testing, the first step involves the nerve __________ up the slack.

<p>taking</p> Signup and view all the answers

Elongation of nerves by 18-22% does not affect blood flow to the nerves.

<p>False (B)</p> Signup and view all the answers

Which of the following terms should never be used when discussing neurodynamic test results?

<p>Positive (D)</p> Signup and view all the answers

Neurodynamics is considered the primary focus in rehabilitation programs.

<p>False (B)</p> Signup and view all the answers

What indicates a neurodynamic response during palpation?

<p>Reproduction of pain.</p> Signup and view all the answers

The _______ plexus injury is one of the differential diagnoses for adverse neurodynamics.

<p>brachial</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>Disc pathology = A condition affecting the spinal discs Radiculopathy = Nerve pain that radiates from the spine Muscle strain = Injury to muscle fibers Stenosis = Narrowing of the spinal canal</p> Signup and view all the answers

What is the primary purpose of nerves sliding longitudinally during movement?

<p>To withstand tension (A)</p> Signup and view all the answers

Adverse neurodynamics is only related to mechanical issues involving the nerves.

<p>False (B)</p> Signup and view all the answers

What are the two directions in which nerves slide mechanically?

<p>Longitudinally and Transversely</p> Signup and view all the answers

Chronic elongation of nerves by _____% can start to create tension issues.

<p>18-22</p> Signup and view all the answers

Match the following convergence points with their respective locations:

<p>C6 = Neck region T6 = Upper thoracic region L4 = Lower back Elbow = Joint region Shoulder = Proximal upper limb Knee = Joint region</p> Signup and view all the answers

Which of the following factors may diminish blood flow to nerves?

<p>Elongation (B)</p> Signup and view all the answers

Sensitization during neurodynamic testing emphasizes the muscular system.

<p>False (B)</p> Signup and view all the answers

What physiological aspects are denoted by the acronym 'BISy' in relation to neurodynamics?

<p>Blood flow, Inflammation, Sensitivity</p> Signup and view all the answers

Flashcards

Neural Tension Types

Neural tension encompasses four related concepts: neural tension, neural tissue tension, dural tension, and neural mechanosensitivity, all connected to how nerve tissue responds to mechanical stress.

Neurodynamics Components

Neurodynamics considers both the mechanics and physiology of nerves. Nerve mechanics involve how nerves slide in response to forces. Nerve physiology includes blood flow, inflammation, and nerve sensitivity in the surrounding tissues.

Neurodynamics Testing Steps

Neurodynamic testing involves three key steps: taking up slack, sliding (longitudinally or transversely), and applying tension, all done sequentially and progressively to avoid injuring the nerve.

Adverse Neurodynamics

Adverse neurodynamics refers to both mechanical (tension or compression issues) and physiological (blood flow or sensitivity issues) problems involving nerves.

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Reduced Nerve Blood Flow Causes

Blood flow to nerves can be reduced or diminished by nerve elongation (up to 18-22% before tension) and compression.

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Nerve Sliding Directions

Nerves slide longitudinally (to withstand tension) and transversely (to withstand compression), these two opposing directional forces are present and necessary.

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Natural Spinal Cord Convergence Locations

These are locations where dura mater (the tough tissue covering the spinal cord) is firmly attached to the bones of the spinal canal. These points create areas of natural tension and stability.

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Neurodynamic Testing Emphasis

Neurodynamic testing should focus on the nervous system. Structural differentiation is used to isolate the nervous system's response to movement, while ensuring that adjacent structures aren't impacting the response.

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Sensitizing Movement in Neurodynamics

Movement designed to increase stress on neural structures, particularly useful for highly flexible individuals to further stretch/compress nerves.

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Neurodynamic Test Terminology

Avoid using "positive" or "negative" when describing test results. Use "normal"/"abnormal" or "clinically relevant" instead.

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Neurodynamics in Rehabilitation

Neurodynamics are a part of rehabilitation, but not the primary focus. Other factors should be addressed first.

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Neurodynamic Palpation

Palpation for adverse neurodynamics should consider potential conditions, injuries, or pathologies that might be linked to the nerve.

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Adverse Neurodynamics Differential Diagnoses

A wide range of conditions can cause adverse neurodynamic responses, including muscle strains, disc issues, nerve problems, and more.

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Neural Tension

A type of adverse neurodynamics where nerves are stretched or elongated, impacting blood flow and potentially causing symptoms.

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Convergence Locations

Natural points along the spine where the dura mater (covering of the spinal cord) attaches to the bone, creating potential areas of tension.

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Structural Differentiation

A technique in neurodynamic testing that isolates the nervous system's response by moving relevant structures without moving adjacent musculoskeletal structures.

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Sensitizing Movement

A type of movement used in neurodynamic testing to increase stress on neural structures, especially helpful for very flexible individuals. It involves stretching and compressing the nerve further.

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Neurodynamic Test Results Terminology

Avoid using 'positive' or 'negative' to describe neurodynamic test results. Instead, use 'normal'/'abnormal' or 'clinically relevant.'

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Neurodynamics in Rehab

Neurodynamics are a part of rehabilitation but not the primary focus. Other factors should be addressed first, like muscles or joints.

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Palpation in Adverse Neurodynamics

When palpating for adverse neurodynamics, consider potential conditions, injuries, or pathologies that might be linked to the nerve.

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Differential Diagnoses for Adverse Neurodynamics

Many conditions can cause adverse neurodynamic responses, including muscle strains, disc issues, nerve problems, and more.

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What are 4 other names for Adverse Neurodynamics?

Adverse Neurodynamics is also known as neural tension, neural tissue tension, dural tension, and neural mechanosensitivity.

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What 2 components are involved in Neurodynamics?

Neurodynamics considers both the mechanics and physiology of nerves. Mechanics involves how nerves physically slide, while physiology involves blood flow, inflammation, and sensitivity within the nerve and its surrounding tissues.

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How do nerves slide mechanically?

Nerves slide longitudinally (to withstand tension) and transversely (to withstand compression).

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What are the 3 steps of spinal cord and nerve movement?

The nerve first takes up slack, then slides towards the pull, and finally elongates.

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Adverse Neurodynamics: Mechanically

Adverse neurodynamics can involve tension or compression issues within the nerves, which can lead to neural symptoms.

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Adverse Neurodynamics: Physiologically

Adverse neurodynamics can also involve blood flow and/or sensitivity issues within the nerves.

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What are 6 convergence points of the dura mater?

The dura mater, the tough covering of the spinal cord, has natural attachment points to the bone canal at C6, T6, L4, elbow, shoulder, and knee.

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What is structural differentiation in neurodynamic testing?

Structural differentiation isolates the nervous system by moving relevant structures without affecting adjacent musculoskeletal structures. It helps determine if the nervous system is the source of the problem.

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What is Adverse Neurodynamics?

Adverse neurodynamics describes problems with nerves related to both how they move (mechanics) and function (physiology). It includes tension, compression, reduced blood flow, and sensitivity issues.

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What may reduced nerve blood flow do to the nervous system?

Reduced blood flow to nerves can lead to various problems within the nervous system, including decreased nerve function and even pain.

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Normal vs Positive

When describing neurodynamic test results, avoid using terms like 'positive' or 'negative.' Instead, use 'normal,' 'abnormal,' or 'clinically relevant' to describe the findings.

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Palpation Considerations

When palpating for adverse neurodynamics, consider potential conditions, injuries, or pathologies that might be linked to the nerve.

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Reduced Nerve Blood Flow

Blood flow to nerves can be reduced by elongation (stretching) and compression.

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Differential Diagnoses: Adverse Neurodynamics

Many conditions can cause nerve problems, including muscle strains, disc issues, nerve entrapment, and more.

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Study Notes

Alternative Names for Neural Tension

  • Neural tissue tension
  • Dural tension
  • Neural mechanosensitivity
  • Mechanics
  • Physiology

Neurodynamics and Nerve Sliding

  • Neurodynamics relates to the mechanical and physiological aspects of nerves
  • Nerves slide longitudinally to resist tension and transversely to resist compression.

Physiological Components of Neurodynamics

  • Blood flow to the nerve and dura
  • Inflammation
  • Sensitivity

Steps of Spinal Cord and Nerve Movement

  • Nerve takes up slack
  • Slides towards pull
  • Elongates

Factors Reducing Blood Flow to Nerves

  • Elongation (up to 18-22% reduction)
  • Compression

Effects of Diminished Nerve Blood Flow

  • Can propagate problems within the nervous system

Adverse Neurodynamics: Mechanical and Physiological Issues

  • Mechanically: Tension and/or compression issues, potentially accompanied by neural symptoms.
  • Physiologically: Blood flow and/or sensitivity issues.

Convergence Points for Spinal Cord and Dura

  • Naturally occurring points where dura is tethered to bone canal, providing stability
  • Locations include C6, T6, L4, elbow, shoulder, knee
  • Locations can experience tension/pulls due to applied stress.

Neurodynamic Testing Procedures

  • Sequential and progressive, avoiding sudden movements
  • Include taking up slack, sliding longitudinally or transversely, and applying tension
  • Test affected side first

Structural Differentiation in Neurodynamic Testing

  • Move relevant structures remotely without affecting adjacent MSK structures
  • Emphasizes nervous system without complete isolation
  • Inconsistency across sides should trigger further investigation.

Sensitizing Movements in Neurodynamic Testing

  • Useful in athletes or individuals with high flexibility for further nerve stretching or compression

Terminology for Neurodynamic Test Results

  • Use "normal," "abnormal," or "clinically relevant" instead of "positive" or "negative"

Neurodynamics in Rehabilitation

  • Neurodynamics is part of rehab, but not the first priority
  • Can be prioritized during optimization phases.

Palpation for Adverse Neurodynamics

  • Palpation should be based on likely conditions or pathologies related to neurodynamics
  • Reproduction of symptoms (neurodynamic response, not a positive test) and side-to-side differences in pain, sensitivity, size/shape/texture are important considerations.

Differential Diagnoses for Adverse Neurodynamics

  • Muscle strain/pathology
  • Disc pathology
  • Radiculopathy
  • Brachial plexus injury
  • Peripheral nerve entrapment
  • Stenosis
  • Tumors
  • Thoracic outlet syndrome
  • Multiple sclerosis
  • Diabetes
  • Cardiac events/angina
  • Chronic regional pain syndrome
  • Myelopathy/upper motor neuron lesion

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